Expert: Gary - 2/6/2005

Question
Hi,
My father-in-law has had empyhsemia for 5 years now.He has recurring bouts of breathing difficulties and when this happens he has to be put on a high dose of steroids which seems to solve the problkem.The dose is gradually reduced to one per day but then after a couple of weeks his breathing problems come back and so the loop continues.
Is there nothing else that can be done for him as it is getting him and his wife down.
Thank you.

Answer
Hi Trevor

Steroids often help with what is called "exacerbations" (a sudden worsening) of emphysema. However, it is common for symptoms to return when the dose of steroids is reduced. Unfortunately, there is a lot of evidence to show that maintaining a high dose of steroids for ever doesn't actually help and, in fact, the side effects of this approach (the steroids) would be dangerous for him. It is important to remember that there is no cure for emphysema and it is a "chronic progressive disease" in other words it gets worse (not better) as time goes by. It could be that you are seeing this natural worsening in your father-in-law's condition.

There are things, however, that can be done (to help symptoms, not to cure). Here are my suggestions:
1. get him to stop smoking if he still does.
2. ask his doctor to arrange for him to get onto a "pulmonary rehabilitation" programme (there is very good evidence that this helps).
3. ask his doctor to make sure he is on the optimal bronchodilator therapy (the inhalers and/or tablets that he takes on a regular basis, but not the steroids)
4. ask his doctor to ensure that his psychological needs are assessed (even if this means trying some anti-depressants) because it is well known that lots of people with emphysema get very low in spirits and this is one aspect of their care that is often under-recognised and neglected. You might think it sounds a bit severe but it often works, this is why: Feeling low means he can't be bothered to do anything, then this leads to inactivity, then this leads to de-conditioning of his muscles, then this leads to more breathlessness when he does use his muscles, then this leads to feeling low... (You probably get the idea... it's a vicious circle)

There are lots of other places you can get advice on his condition. You can try searching for "emphysema" (make sure you spell it right because you got it wrong in the question you sent me). Or, you can also try searching for "COPD" which stands for "chronic obstructive pulmonary disease" because emphysema is a part of this condition.

Good luck

Gary